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To the Editor: Dr Corwin and colleagues¹ reported that recombinant human erythropoietin (rHuEPO) resulted in a 10% absolute reduction in number of critically ill patients who underwent transfusion with red blood cells (RBCs) and in a 19% relative reduction in the units of RBCs transfused. Most of these patients, however, were not anemic, with mean baseline hemoglobin levels of 9.97 g/dL and mean pretransfusion levels of approximately 8.50 g/dL. Nonetheless, 21% of patients received RBC transfusions for hemoglobin levels greater than 9 g/dL. In the absence of myocardial ischemia or recognized blood loss, these treatment decisions would appear to contradict the evidence of the lack of significant benefit and trends toward harm demonstrated with intervention to maintain hemoglobin levels of 9 g/dL.² Indeed, subgroup analysis of RBC transfusion requirements demonstrated no significant difference between the groups when baseline hemoglobin levels were less than 9 g/dL.

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